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Good Morning.

At a recent medical conference, a primary care doctor made a striking comment: “We are overwhelmed with advanced metabolic diseases. We need help from others earlier in the process.” This made me realize that we, as dentists, see patients more often than primary care doctors, who usually see them when they already have issues like high blood sugar, high blood pressure, weight gain, tiredness, or heart problems. Dentists see patients before these problems are diagnosed or treated, and the medical field is starting to recognize this.

5-minute read👇

The Silent Epidemic in Our Hygiene Chairs

Metabolic syndrome is not rare.

It is common, growing, and frequently undiagnosed. The constellation of central obesity, hypertension, insulin resistance, and dyslipidemia dramatically increases risk for type 2 diabetes and cardiovascular disease (Grundy et al., 2005; Saklayen, 2018).

Now consider what we routinely see:

• Persistent periodontal inflammation

• Delayed healing

• Xerostomia

• Obstructive sleep apnea

• Central adiposity

• Elevated in-office blood pressure

The relationship between periodontal disease and metabolic dysfunction is well established. Periodontitis and diabetes demonstrate a bidirectional relationship mediated by systemic inflammation (Preshaw et al., 2012). Metabolic syndrome has also been independently associated with increased periodontal disease prevalence and severity (Nibali et al., 2007).

Chronic inflammation is the bridge. And inflammation is our language.

Primary Care Is Jealous of Your Recall System

For instance, a 50-year-old patient in the UK had a routine dental check-up where a simple glucose screening revealed undiagnosed diabetes. After referral and medical management, her blood sugar normalized, and her gum health improved significantly. Click here for the rest of the story.

Dentistry has the most reliable recall system in adult healthcare.

We see “healthy” 35-, 45-, and 55-year-olds every six months.

Primary care does not.

Research shows a substantial proportion of adults visit a dentist annually but do not see a physician during that same period (Strauss et al., 2012). That makes dentistry one of the most consistent health touchpoints in the United States.

This is not a coincidence. It is an opportunity.

This Is Responsible Screening

Let's make this simple. We're not diagnosing diabetes or managing high blood pressure, and we're not taking the place of primary care doctors. Our goal is to identify risks and refer patients to the right professionals. Dentists already do things like check for oral cancer, measure blood pressure, identify sleep issues, and record detailed medical histories. Adding checks for metabolic health is just a natural next step.

During appointments, dentists can ask questions like:

- "Has your doctor ever talked to you about blood sugar or prediabetes?"

- "Are you being treated for high blood pressure?"

If needed, we might say: "Based on what we see in your mouth and your medical history, I suggest you see a primary care doctor to check for metabolic risks." This approach shows leadership, not overstepping boundaries.

The Surgical Reality: Healing Capacity Matters

For those of us who perform dental procedures such as implant placement, grafting, extractions, or major gum treatments, understanding a patient's metabolic health is crucial. High blood sugar can weaken the body's ability to fight infections, heal wounds, and form new blood vessels and collagen. Poor blood sugar control can lead to more problems with implants and slower healing. Therefore, before surgery, it's important to know a patient's blood sugar levels to manage risks effectively.

In-Office Blood Glucose Screening: A Practical Approach

If a dentist wishes to incorporate objective metabolic screening, a simple finger-stick capillary glucose measurement is feasible and supported by literature demonstrating the utility of dental office screening (Lalla et al., 2011).

Dentists should confirm state-specific CLIA waiver requirements before implementing in-office glucose or HbA1c testing.

Recommended Method

1. Point-of-Care Glucometer

• FDA-approved handheld device

• Single-use lancet

• Capillary blood drop

• Immediate reading

2. Fasting Glucose (if possible)

• ≥ 126 mg/dL suggests diabetes

• 100–125 mg/dL suggests impaired fasting glucose

3. Random Glucose

• ≥ 200 mg/dL with symptoms suggests diabetes

4. Point-of-Care HbA1c (Preferred for Surgical Planning)

• Many CLIA-waived in-office systems are available

• A1c ≥ 6.5% consistent with diabetes

• A1c 5.7–6.4% indicates prediabetes

For implant or graft surgery, documenting recent A1c is especially valuable. If A1c is elevated, coordinate with the patient’s physician before proceeding.

This is not about becoming an endocrinologist.

It is about reducing postoperative complications and protecting outcomes.

The Bigger Identity Question

Is dentistry just about procedures, or is it a part of overall health that focuses on the mouth? I believe it's the latter, which means we can't overlook metabolic syndrome.

Providing good care benefits everyone: patients trust us more, doctors respect us more, complications are fewer, and results improve. The medical field is seeking partners to address health issues early, and we're well-positioned to help. The question is, will we take on this role?

– Dr Mike Bennett

Selected Peer-Reviewed References

Grundy, S. M., et al. (2005). Diagnosis and management of the metabolic syndrome. Circulation, 112(17), 2735–2752.

Saklayen, M. G. (2018). The global epidemic of the metabolic syndrome. Current Hypertension Reports, 20(2), 12.

Preshaw, P. M., et al. (2012). Periodontitis and diabetes: a two-way relationship. Diabetologia, 55(1), 21–31.

Nibali, L., et al. (2007). Association between metabolic syndrome and periodontitis. Journal of Clinical Endocrinology & Metabolism, 92(10), 3649–3655.

Guo, S., & DiPietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219–229.

Oates, T. W., et al. (2009). Glycemic control and implant stabilization. Journal of Dental Research, 88(4), 367–371.

Lalla, E., et al. (2011). Dental findings and identification of undiagnosed hyperglycemia. Journal of Dental Research, 90(7), 855–860.

Marhoffer, W., et al. (1992). Impairment of neutrophil function in poorly controlled diabetes. Diabetes Care, 15(2), 256–260.

🍭Stuff so sweet you might get a cavity.

Forward this newsletter to a colleague or sleep physician partner. Let’s grow the movement, one documented, approved, and healed patient at a time.

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